Dive Fest Registration Form

Name ____________________________

Address __________________________

_________________________________

Phone Number _____________________

Certification Level __________________

T-Shirt Size  M    L    XL     XXL

Emergency Contact Information:

Name ____________________________

Phone Number _____________________

Cost Work Sheet

MSD Dive Fest Registration:

  Paid in full before Sept. 11th $55.00

                or after Sept. 11th $65.00

  or daily rate of $20.00 / day  __________

   Number of nights camping

              ______ x $3.00 / night ________

        YOUR TOTAL $________ 

Don't forget every vehicle entering Portsmouth
Campground MUST HAVE a CURRENT State park pass!

Return This registration sheet and the Liability form
with full payment to MSD
    FAX 218-828-7909  
or mail to 712 Washington Street, Brainerd, MN 56401